How Do The Community Health Nurses’ Experience in The Strategies of Non-Communicable Disease (NCD) Promotion and Prevention?

Nurses have an important task in the strategy of intervention to reduce of Non-Communicable Diseases (NCD)’ incidence. Community health nurses have tried to control the problem of NCD. However, the incidence of NCD has not decreased as expected. The promotion and prevention of non-communicable diseases are one of the efforts to control PTM. This study aims to explore the experience of nurses in implementing the strategies of NCD’ promotive and preventive. This study used a qualitative descriptive phenomenological design. A total of 16 community health nurses were selected using purposive sampling. The inclusion criteria of this study were (1) nurses who served at the community health center for a minimum of 6 months, (2) performed individual health services in the community health center and carried out family visits and services in the community. The data were analyzed using Colaizzi's approach. This research was approved by the Committee of Ethics in the Faculty of Nursing, Universitas Indonesia. This study resulted in five strategies of nurses implementing to NCD’ promotion and prevention, include (1) health education, (2) partnership with community health workers, (3) coordination, (4) stand with the community, (5) monitoring the change of behavior in the community. Nurses’ experience of NCD’s promotion and prevention in the community health center still needs improvement to achieve holistic and comprehensive health services. Nurses should be attention to the preparation of themselves before implementing the promotion and prevention, such as preparation of the topic, communication with colleagues and communities, and doing a partnership with multisectoral.


INTRODUCTION
Non-communicable diseases (NCD) was one of the causes of death in developing countries (Khetan et al., 2017). A report by the World Health Organization states that NCD caused 40 million deaths globally (WHO, 2017b). The death of NCD was caused by four major diseases, such as 45% from cardiovascular disease, 22% from cancer, 10% from acute respiratory disease, and 4% from diabetes mellitus (WHO, 2017a). Southeast Asia was significantly in mortality by NCD for twelve years, from 6.7 million deaths to 8.5 This condition can be interpreted that NCD suffered by adults and the elderly. A person aged 30 years had a 19% chance of dying before 70 years (WHO, 2014 This condition showed that noncommunicable diseases were still a priority problem to be solved immediately in West Java. Community health nurses were one of the health workers at the forefront of public health services (Roden et al., 2016).
Community health nurses in Indonesia were known as primary health nurses based on the concept of nursing center (Kementerian Kesehatan RI, 2006;Kementerian Kesehatan RI, 2014). Nurses had a responsibility to improve the healthy behavior of the community through promotive and preventive efforts (Kementerian Kesehatan RI, 2006). Most nurses agreed that promoting promotive and preventive was the critical value in their work (DeCola et al., 2012;Brobeck et al., 2013). According to the research of Wilhelmsson and Lindberg (2009) and Whitehead (2009)   The implementation of NCD's promotion and prevention by nurses was a very complex phenomenon in Indonesia. The complex problems were part of the characteristics that require a qualitative approach as a method of resolution (Creswell, 2007

Strategy [1]: Health Education
Health education was carried out according to the schedule by each primary health center. Not only health education times were scheduled, but also the nurses have The preparation of health education topics adjusted patient problems and sometimes was adjusted to a health day celebration.  (Casey, 2007a;Lock et al., 2002;Saarmann, Daugherty, & Riegel, 2002). Therefore, nurses should improve their ability to search for references for NCD's concept.
In research, Maijala, Tossavainen and Turunen (2016) (Nies and McEwen, 2015). The social ecology model also explained the community behavior associated with preventing the diseaserelated with organizational, community, and population factors (Edberg, 2013).  "I have to trust the patient… must cooperate… but if the patient is uncooperative or distrustful, we will certainly guide him." "I involve (re: family) it is impossible to visit continuously" (P9)

Strategy [3]: Coordination
One nurse involved the clients as a health educator to share experiences when they get diagnosed with NCD. Nurses created therapeutic relationships as a key in implementing health promotion (Casey, 2007a;Svedberg, Jormfeldt and Arvidsson, 2003). The feeling of trust was an important part of making confidence for clients in improving healthy behaviors. It is also by the concept that nurses should involve clients and their families in implementation and evaluation (Berman, Snyder and Frandsen, 2016).  (Watson, 2003). A social cognitive theory explained the success of behavior change related to self-confidence from positive responses and affirmations (Stanhope and Lancaster, 2020 shown that warning about signs and symptoms of stroke disease by television, video, and radio which more effective in increasing health promotion (Jurkowski et al., 2010;Worthmann et al., 2013).

Strategy [4]: Stand with the community
However, Casey (2007a) showed that an autocratic approach (give a warning) should not be made in this study.
Negotiation was the best approach to consider the clients when decided the treatment to improve healthy behaviors (Casey, 2007a

ACKNOWLEDGEMENT
We would like to thank The Department of Health in Depok and all the nurses of the community health centre at Depok who participated in the study. We would also like to thank you for allowing us to